硬膜外阻滞辅助力月西的临床观察

硬膜外麻醉中病人常有紧张、焦虑、内脏牵拉等不良反应，严重的甚至出现短暂难以忍受的强烈刺激，而术中知晓也加重病人的心理压力和恐惧感，给病人留下痛苦的回忆，并造成身心的伤害。此外，硬膜外阻滞为不完善的麻醉技术，应用于腹部手术即使麻醉效果确切，也因为内脏牵拉等需要使用辅助药。为了消除病人在麻醉和手术中的不良反应，提高医疗质量，我们选用力月西。本研究宗旨在观察力月西在硬膜外麻醉术中的镇静遗忘作用效果，现报告如下。[第一段]     

利多卡因复合氯胺酮对全脑缺血大鼠海马细胞凋亡的影响

Objective To investigate the effect of lidocaine combined ketamine to the cells necrosis and apoptosis in the CA1 region of rat hippoeampus following global cerebral ischemia-reperfusion. Methods Sixty adult Wistar rats were randomly divided into 6 groups:control group(Ⅰ, n=4),sham operation group (Ⅱ, n=4), model group (Ⅲ, n =4), lidoeaine group (Ⅳ, n =16), ke-tamine group(Ⅴ, n=16), lidocaine and ketamine group (Ⅵ, n=16). The global cerebral ischemia (10 min) was induced by the use of the four-vessel occlusion method. Group Ⅳ,Ⅴ,Ⅵ intraperitoneally injected the lidocaine 10mg/kg, ketamine 10 mg/kg or lidocaine combined ketamine 10 mg/kg. The effect of cells necrosis and apoptosis was detected by using HE staining and TUNEL methods. Results Compared with group Ⅱ the numbers of ischemia neuron of group Ⅳ, Ⅴ, Ⅵ had significant deviation (P<0.05) in 24 h, and group Wl had significant decreased than group Ⅳ, Ⅴ(P<0.05). The isehemia neurons peak presented in 24 h. Compared with group Ⅱ the numbers of apoptosis of group Ⅳ,Ⅴ,Ⅵ had significantly deviation (P<0.05)in 24 h, and group Ⅵ had significantly decreased than group Ⅳ,Ⅴ (P<0.05). The apoptosis peak presented in 24 h and 48 h, and decreased during reperfusion time. Conclusion Li-doeaine combined ketamine can reduce the cell necrosis and apoptosis after global erebral isehemia-reperfusion in rats hippocampus.     

利多卡因复合氯胺酮对全脑缺血大鼠海马细胞凋亡的影响

Objective To investigate the effect of lidocaine combined ketamine to the cells necrosis and apoptosis in the CA1 region of rat hippoeampus following global cerebral ischemia-reperfusion. Methods Sixty adult Wistar rats were randomly divided into 6 groups:control group(Ⅰ, n=4),sham operation group (Ⅱ, n=4), model group (Ⅲ, n =4), lidoeaine group (Ⅳ, n =16), ke-tamine group(Ⅴ, n=16), lidocaine and ketamine group (Ⅵ, n=16). The global cerebral ischemia (10 min) was induced by the use of the four-vessel occlusion method. Group Ⅳ,Ⅴ,Ⅵ intraperitoneally injected the lidocaine 10mg/kg, ketamine 10 mg/kg or lidocaine combined ketamine 10 mg/kg. The effect of cells necrosis and apoptosis was detected by using HE staining and TUNEL methods. Results Compared with group Ⅱ the numbers of ischemia neuron of group Ⅳ, Ⅴ, Ⅵ had significant deviation (P<0.05) in 24 h, and group Wl had significant decreased than group Ⅳ, Ⅴ(P<0.05). The isehemia neurons peak presented in 24 h. Compared with group Ⅱ the numbers of apoptosis of group Ⅳ,Ⅴ,Ⅵ had significantly deviation (P<0.05)in 24 h, and group Ⅵ had significantly decreased than group Ⅳ,Ⅴ (P<0.05). The apoptosis peak presented in 24 h and 48 h, and decreased during reperfusion time. Conclusion Li-doeaine combined ketamine can reduce the cell necrosis and apoptosis after global erebral isehemia-reperfusion in rats hippocampus.     

异丙酚对大鼠海马神经细胞内游离钙和钙调蛋白活性的影响

目的观察一次性注射异丙酚对Wistar＇s大鼠海马神经细胞内游离钙（[Ca^2＋]i）和钙调蛋白（calmodulin，CaM）相对活性的影响。方法40只Wistar＇s大鼠随机分为5组，即对照组、诱导期组、麻醉期组、恢复期组、清醒期组。对照组腹腔注射生理盐水10ml／kg，其余各组注射异丙酚100mg／kg．在不同麻醉时期断头取脑，用流式细胞术测定海马神经细胞内[Ca^2＋]i和CaM相对活性。结果①麻醉诱导后海马神经细胞内[Ca^2＋]i与对照组比较升高有统计学意义（P〈0．01）．②CaM平均荧光强度诱导期与对照组及恢复期比较升高有统计学意义（P〈0．05），恢复期其活性接近对照组水平（P〉0．05）。结论Wistarg大鼠腹腔注射异丙酚100mg／kg即刻可明显影响其海马神经细胞内[Ca^2＋]i和CaM相对活性。CaM作为信号分子在异丙酚全麻作用的分子学机制中发挥了一定作用。     

罗哌卡因在老年患者全髋关节置换术中髋关节囊周围神经阻滞的半数有效浓度

目的 测定全麻联合髋关节囊周围神经（PENG）阻滞用于全髋关节置换术老年患者的罗哌卡因半数有效浓度（EC₅₀）。

方法 选择择期行全髋关节置换术的老年患者36例,男20例,女16例,年龄65～80岁,BMI 18～30 kg/m²,ASA Ⅱ或Ⅲ级。在超声引导下行PENG阻滞,设定罗哌卡因容量为20 ml,浓度由序贯法确定,初始浓度为0.375%,若神经阻滞20 min后,静息NRS评分较阻滞前下降≥2分且活动时NRS评分较阻滞前下降≥3分时,则视为阻滞成功,反之则视为失败,阻滞失败则下1例患者提高1个浓度梯度,阻滞成功则下1例患者降低1个浓度梯度,相邻浓度比值为1.0∶1.2,直至出现7个拐点。采用Probit概率法计算罗哌卡因的EC₅₀及其 95%可信区间（CI）。记录PENG阻滞前（阻滞前）、阻滞后20 min和术后2、6、12、24 h静息和活动（被动抬髋15°）时NRS评分,术后穿刺部位感染、血肿、神经损伤、局麻药中毒、恶心、呕吐、头晕等发生情况。

结果 罗哌卡因用于老年患者全髋关节置换术前行PENG阻滞的EC₅₀为0.185%（95%CI 0.154%～0.213%）。无一例患者穿刺部位感染、血肿、神经损伤、局麻药中毒并发症。

结论 罗哌卡因用于老年患者全髋关节置换术中PENG阻滞的EC₅₀为0.185%（95%CI 0.154%～0.213%）。     

小儿术后静脉自控镇痛安全性探讨

背景 阿片类药物为主的小儿静脉自控镇痛能有效缓解术后中重度疼痛,提高患儿及家属的满意度,改善预后.目的 关注小儿术后静脉自控镇痛呼吸抑制相关高危因素和具有争议性的问题,提高小儿术后疼痛治疗的安全性和有效性,确保患儿用药安全. 内容 受阿片类药物副作用、术后镇痛实施管理和镇痛装置自身等多种不良因素的影响,尤其是药物引起的呼吸抑制,使小儿术后静脉自控镇痛的安全性备受关注. 趋向 有效预防和治疗小儿术后静脉自控镇痛副作用尤为重要.     

静脉复合丙泊酚紧急气管插管在重度颅脑损伤急救中的应用

目的：探讨静脉复合丙泊酚在重型颅脑损伤急救中的作用。方法：回顾性分析132例重型颅脑损伤患者,在急救过程中静脉复合丙泊酚,早期控制气道,积极预防脑外伤并发症的作用。结果：本组中低氧血症103例得到纠正;有效防止了误吸的发生,加强了对气道的管理;插管应激反应明显减轻;颅内高压得到改善。结论：合理使用丙泊酚明显减少了重型颅脑损伤急救中的并发症,为后期治疗创造了条件,提高了重型颅脑损伤患者抢救的成功率。     

术后疼痛管理的研究进展

术后疼痛（Postoperative pain）不仅给患者带来痛苦,还给其带来严重的心理及生理损伤,增加并发症的发生率。有效缓解术后疼痛,提高患者的生活质量,是众多临床学者当前面临的主要课题。